1. Cardiovascular Examination Dr. Aisha AL-Ghamdi Associate professor Consultant internist

2. Cardiovascular Examination General examination. Heart examination.

3. Cont. Blood pressure (supine & erect, why?). Signs of heart failure in other organs (lungs, liver, lower limbs ) Signs of heart failure in other organs (lungs, liver, lower limbs ) Fundus examination (arterial changes, haemorrhages, exudates and papilloedema) in arterial hypertension.

4. Radial arterial puls. 1. Rate: average =70/min (range,60-90). increased & decreased in some conditions what are they ? 2. Rhythm. 3. Form of pulse wave. 4. Volume. 5. Vessel wall. 6. Synchronicity with other radial artery delay? 7. Radio femoral delay (aortic coarctation).

5. Jagular venous pressure(JVP). Position of the patient at (45), head. Features of JVP, how to differentiate with carotid pulsation in the neck. Hepato-jugular reflex’. Waves (a, c, x, v, y)

6. Heart examination; Inspection : 1. Apex beat. 2. left parasternal movement due to right ventricular hypertrophy. 3. pulsation in 2d left ICS 2ry to enlarged PA. 4. epigastric pulsation 2ry to expanded abdominal aorta

7. Cont. heart exam. Palpation : 1. Apex beat 5 th ICS midclavicular line. 2. Left parasternal heave 2 nd ICS 2 ry to RVH. 3. Thrill (vibrating sensation indicates palpable murmur).

8. Cont. heart exam. Auscultation: Auscultation: 1. bell to detect low-pitched sounds, press lightly against the skin 2. diaphragm detect high-pitched sounds press firmly against the skin press firmly against the skin

9. Cont. auscultation Normally audible heart sounds: 1 st & 2 nd HS 1 st & 2 nd HS Added sounds: 3 rd & 4 th HS, pericardial friction rub (pericarditis), opening snap (m.s), mitral click(m.v.p) murmers

10. Murmurs Turbulent blood flow caused by diseased valve or if a large amount of blood flows through a normal valve. characteristics of murmurs suggest the cause of it (site, radiation, pitch, timing and the intensity). characteristics of murmurs suggest the cause of it (site, radiation, pitch, timing and the intensity).

11. Cont. Site; area over which a murmur is best heared depends upon the valve of origin and the direction of the blood flow. (Mitral m.at apex, aortic m.at right 2 nd ICS) Radiation; occurs along line of blood flow. (AS» neck, AR» left sternal edge.)

12. Cont. Pitch; the greater the pressure gradient the higher the pitch(MS m.» low-pitched, AR m.» high-pitched) Timing; in relation to the1 st and the 2 nd HS Systolic; time between 1 st and the 2 nd HS, could be mid-systolic (AS), pansystolic (MR). Diastolic; time between 2 nd and the 1 st HS, can be divided into three phases. Early (AR), Mid- diastole (MS), Presystole.

13. Cont. Examples of murmurs; Systolic; MR,TR, AS, PS. Diastolic; MS,TS, AR, PS. Continuous; PDA.

14. Signs of cardiac failure: Elevation of the JVP. Gallop rhythm (tachycardia and 3 rd HS). Basal crepitations. Hepatomegaly. Dependent pitting oedema.

15. Examination of peripheral arteries: All pulses should be examined. What are they ?? Look for bruit (indicates arterial stenosis), Pallor,,Paralysis. ( Look for signs of arterial insufficiency. 5Ps Pain, Pallor, Pulselessness, Paresthesias,,Paralysis. (Pain is the earliest sign) are the signs of acute leg ischemia.

16. Examination of peripheral veins: inflammation or thrombosis of a vein may cause local discomfort or pain. Manifestations of venous obstruction depends on site, extent and adequacy of collateral vessels Cyanosis and oedema are signs of venous obstruction.